Provider Demographics
NPI:1083989628
Name:MAZARAKOS, HEATHER K (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:MAZARAKOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-6014
Mailing Address - Country:US
Mailing Address - Phone:203-335-5225
Mailing Address - Fax:203-336-2851
Practice Address - Street 1:141 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1014
Practice Address - Country:US
Practice Address - Phone:203-602-4441
Practice Address - Fax:203-602-7782
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007902101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health